INTELLECTUAL DISABILITY PART- I

DR. SUBRATA NASKAR

INTELLECTUAL DISABILITYPART - I

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DEFINITION• THE AMERICAN ASSOCIATION OF INTELLECTUAL & DEVELOPMENTAL

DISABILITIES (AAIDD) HAS DEFINED INTELLECTUAL DISABILITY AS A DISABILITY CHARACTERIZED BY SIGNIFICANT LIMITATIONS IN BOTH INTELLECTUAL FUNCTIONING AND IN ADAPTIVE BEHAVIOUR, WHICH COVERS MANY EVERYDAY SOCIAL AND PRACTICAL SKILLS WHICH ORIGINATES BEFORE THE AGE OF 18.

• THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, FIFTH EDITION (DSM-V) 7 DEFINES INTELLECTUAL DISABILITY AS FOLLOWS:• “INTELLECTUAL DISABILITY (INTELLECTUAL DEVELOPMENTAL DISORDER) IS

A DISORDER WITH ONSET DURING THE DEVELOPMENTAL PERIOD THAT INCLUDES BOTH INTELLECTUAL AND ADAPTIVE FUNCTIONING DEFICITS IN CONCEPTUAL, SOCIAL, AND PRACTICAL DOMAINS.”

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HISTORY• THE EARLIEST REFERENCE TO

INTELLECTUAL DISABILITY DATES TO THE EGYPTIAN PAPYRUS OF THEBES IN 1552 B.C. (HARRIS 2006)

• GREEK AND ROMAN PHILOSOPHERS, WHO VALUED REASONING ABILITIES, DISPARAGED PEOPLE WITH INTELLECTUAL DISABILITIES AS BARELY HUMAN.

THE EBERS PAPYRUS (1550 BC) FROM ANCIENT EGYPT

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• THE OLDEST PHYSIOLOGICAL VIEW OF INTELLECTUAL DISABILITY IS IN THE WRITINGS OF HIPPOCRATES IN THE LATE FIFTH CENTURY B.C. WHO BELIEVED THAT IT WAS CAUSED BY AN IMBALANCE IN THE FOUR HUMORS IN THE BRAIN.

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• UNTIL THE ENLIGHTENMENT IN EUROPE, CARE AND ASYLUM WAS PROVIDED BY FAMILIES AND THE CHURCH (IN MONASTERIES AND OTHER RELIGIOUS COMMUNITIES), FOCUSING ON THE PROVISION OF BASIC PHYSICAL NEEDS SUCH AS FOOD, SHELTER AND CLOTHING. NEGATIVE STEREOTYPES WERE PROMINENT IN SOCIAL ATTITUDES OF THE TIME.

• IN THE 13TH CENTURY, ENGLAND DECLARED PEOPLE WITH INTELLECTUAL DISABILITIES TO BE INCAPABLE OF MAKING DECISIONS OR MANAGING THEIR AFFAIRS. GUARDIANSHIPS WERE CREATED TO TAKE OVER THEIR FINANCIAL AFFAIRS.

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• IN THE 17TH CENTURY, THOMAS WILLIS PROVIDED THE FIRST DESCRIPTION OF INTELLECTUAL DISABILITIES AS A DISEASE. HE BELIEVED THAT IT WAS CAUSED BY STRUCTURAL PROBLEMS IN THE BRAIN. ACCORDING TO WILLIS, THE ANATOMICAL PROBLEMS COULD BE EITHER AN INBORN CONDITION OR ACQUIRED LATER IN LIFE.

• IN THE 18TH AND 19TH CENTURIES, HOUSING AND CARE MOVED AWAY FROM FAMILIES AND TOWARDS AN ASYLUM MODEL. CHILDREN WITH INTELLECTUAL DISABILITIES AND BEHAVIOURAL ABNORMALITIES WERE REMOVED FROM THEIR FAMILIES AND PLACED IN SPECIALIZED INSTITUTIONS WHICH PROVIDED VERY MINIMAL BASIC EDUCATION AND SURVIVED ON THE SERVICES PROVIDED THE RESIDENTS.

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• JEAN-MARC ITARD IS CREDITED WITH CREATING THE FIRST SYSTEMATIC INTERVENTION PROGRAM FOR A PERSON WITH INTELLECTUAL DISABILITY IN LATE 18TH CENTURY FRANCE, AND THE FIRST RESIDENTIAL FACILITY WAS FOUNDED IN THE MID-19TH CENTURY IN SWITZERLAND.

• IN THE LATE 19TH CENTURY, IN RESPONSE TO CHARLES DARWIN'S ON THE ORIGIN OF SPECIES, FRANCIS GALTON PROPOSED SELECTIVE BREEDING OF HUMANS TO REDUCE INTELLECTUAL DISABILITIES. • PSYCHOLOGICAL TESTS TO ASSESS INTELLIGENCE WERE DEVELOPED IN THE 20TH CENTURY,

WHICH INCREASED CASE IDENTIFICATION.

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• EARLY IN THE 20TH CENTURY THE EUGENICS MOVEMENT BECAME POPULAR THROUGHOUT THE WORLD WHICH LED TO FORCED STERILIZATION AND PROHIBITION OF MARRIAGE IN MOST OF THE DEVELOPED WORLD AND WAS LATER USED BY ADOLF HITLER AS A RATIONALE FOR THE MASS MURDER OF INTELLECTUALLY CHALLENGED INDIVIDUALS DURING THE HOLOCAUST.

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‘FEEBLEMINDEDNESS’

‘IDIOCY’

‘MENTAL SUB NORMALITY’

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• THE TERM 'MENTAL RETARDATION' WAS INTRODUCED BY THE AMERICAN ASSOCIATION ON MENTAL RETARDATION IN 1961, AND SOON AFTERWARDS WAS ADOPTED BY THE AMERICAN PSYCHIATRIC ASSOCIATION (APA) IN ITS DIAGNOSTIC AND STATISTICAL MANUAL FOR MENTAL DISORDERS (DSM).

• MENTAL RETARDATION REPLACED OLDER TERMS SUCH AS ‘FEEBLEMINDEDNESS’, ‘IDIOCY’, AND ‘MENTAL SUB NORMALITY’ THAT HAD BECOME PEJORATIVE.

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THE JOURNEY FROM MENTAL RETARDATION TO INTELLECTUAL

DISABILITY

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• ROSA MARCELLINO, AN 8-YEAR-OLD GIRL WITH DOWN SYNDROME FROM MARYLAND, WAS TAUNTED FREQUENTLY AND PEJORATIVELY CALLED 'RETARD' IN A DEMEANING MANNER.

• WITH SUPPORT FROM HER STATE REPRESENTATIVE AND U.S SENATOR BARBARA MIKULSKI, LEGISLATION WAS INITIATED LEADING TO THE CHANGE IN THE LAW.

• THE TERM 'MENTAL RETARDATION' HAS BEEN ELIMINATED IN THE UNITED STATES, A FEDERAL STATUTE (PUBLIC LAW 111-256, ROSA'S LAW) REPLACES THE TERM 'MENTAL RETARDATION' WITH 'INTELLECTUAL DISABILITY' AND REQUIRES THAT PERSON FIRST LANGUAGE BE USED WHEN REFERRING TO THOSE AFFECTED IN ALL FEDERAL LAWS.

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• THE NEW TERM PROPOSED IN DSM-5 IS INTELLECTUAL DISABILITY (ID).

• THE NEW DSM-5 CATEGORY IS SYNONYMOUS WITH THE PROPOSED ICD-11 DIAGNOSIS OF IDDS, IN THAT IT REFERS TO A HEALTH CONDITION OR DISORDER.

• THE ICD-11 WORKING GROUP HAS PROPOSED REPLACING MENTAL RETARDATION WITH INTELLECTUAL DEVELOPMENTAL DISORDERS (IDDS), A TERM IT DEFINES AS 'A GROUP OF DEVELOPMENTAL CONDITIONS CHARACTERIZED BY SIGNIFICANT IMPAIRMENT OF COGNITIVE FUNCTIONS, WHICH ARE ASSOCIATED WITH LIMITATIONS OF LEARNING, ADAPTIVE BEHAVIOUR AND SKILLS'.

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WHO ARE THE INTELLECTUALLY DISABLED ?

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DSM V CRITERIA• THE FOLLOWING THREE CRITERIA MUST BE MET:

• DEFICITS IN INTELLECTUAL FUNCTIONS, SUCH AS • REASONING• PROBLEM SOLVING• PLANNING• ABSTRACT THINKING• JUDGMENT• ACADEMIC LEARNING• LEARNING FROM EXPERIENCE

• CONFIRMED BY BOTH CLINICAL ASSESSMENT AND INDIVIDUALIZED, STANDARDIZED INTELLIGENCE TESTING.

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DSM V CRITERIA• DEFICITS IN ADAPTIVE FUNCTIONING THAT RESULT IN FAILURE TO MEET

DEVELOPMENTAL AND SOCIOCULTURAL STANDARDS FOR PERSONAL INDEPENDENCE AND SOCIAL RESPONSIBILITY.

• WITHOUT ONGOING SUPPORT, THE ADAPTIVE DEFICITS LIMIT FUNCTIONING IN ONE OR MORE ACTIVITIES OF DAILY LIFE, SUCH AS COMMUNICATION, SOCIAL PARTICIPATION, AND INDEPENDENT LIVING, ACROSS MULTIPLE ENVIRONMENTS, SUCH AS HOME, SCHOOL, WORK, AND COMMUNITY.

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DSM V CRITERIA• ONSET OF INTELLECTUAL AND ADAPTIVE DEFICITS DURING THE

DEVELOPMENTAL PERIOD

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GENERAL INTELLECTUAL FUNCTIONING

• IT IS DEFIENED AS THE RESULTS OBTAINED BY THE ADMINISTRATION OF A STANDARDIZED GENERAL INTELLIGENCE TESTS DEVELOPED FOR THE PURPOSE AND ADAPTED TO THE CONDITIONS OF THE REGION/ COUNTRY.

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SUBNORMAL INTELLECTUAL FUNCTIONING• SUB-AVERAGE INTELLECTUAL FUNCTIONING IS DEFINED AS “AN IQ OF

ABOUT 70 OR BELOW (APPROXIMATELY 2 STANDARD DEVIATIONS BELOW THE MEAN).

• STANDARD ERROR OF MEASUREMENT IS 3 OR 4 POINTS OVER OR UNDER THE SCORE OBTAINED ON A PARTICULAR TEST.

• ZONE OF UNCERTAINTY – I.Q = 66-74

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ADAPTIVE BEHAVIOUR• IT IS DEFIENED AS THE DEGREE WITH WHICH THE INDIVIDUAL MEETS

THE STANDARDS OF PERSONAL INDEPENDENCE & SOCIAL RESPONSIBILITY EXPECTED OF HIS AGE & CULTURAL GROUP. THE EXPECTATION OF ADAPTIVE BEHAVIOUR VARY WITH THE CHRONOLOGICAL AGE.

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IMPAIRMENT IN ADAPTIVE BEHAVIOUR• DURING INFANCY & EARLY

CHILDHOOD:

1. SENSORY & MOTOR SKILL DEVELOPMENT.

2. COMMUNICATION SKILLS [ SPEECH & LANGUAGE)

3. SELF HELP SKILLS.4. SOCIALIZATION.

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DURING CHILDHOOD & ADOLESCENCE

1. APPLICATION OF BASIC ACADEMIC SKILLS TO

DAILY LIFE ACTIVITIES.

2. APPLICATION OF APPROPRIATE REASONING &

JUDGEMENT IN THE MASTERY OF THE

ENVIORNMENT.

3. SOCIAL SKILLS

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DURING LATE ADOLESCENCE & ADULT LIFE

VOCATIONAL TRAINING & SOCIAL RESPONSIBILITIES.

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NORMALDEVELOPMENTAL MILESTONES

1ST TWO YEARS

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CLASSIFICATION

30DSM 5

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32ICD 10

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PROPOSED ICD 11 CRITERIA FOR INTELLECTUAL DEVELOPMENTAL DISORDER

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THERE ARE THREE REQUIREMENTS FOR A DIAGNOSIS OF DISORDERS OF ID• THE PRESENCE OF SIGNIFICANT LIMITATIONS IN INTELLECTUAL

FUNCTIONING• THE PRESENCE OF SIGNIFICANT LIMITATIONS IN ADAPTIVE

BEHAVIOUR• ONSET DURING THE DEVELOPMENTAL PERIOD.

Marc J. Tassé, Ruth Luckasson, and Margaret Nygren (2013) AAIDD Proposed Recommendations for ICD–11 and the Condition Previously Known as Mental Retardation. Intellectual and Developmental Disabilities: April 2013, Vol. 51, No. 2, pp. 127-131.doi: http://dx.doi.org/10.1352/1934-9556-51.2.127

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ICD 11 PROPOSED CLASSIFICATION OF IDD• DISORDER OF INTELLECTUAL DISABILITY, MARKED

• DISORDER OF INTELLECTUAL DISABILITY, EXTENSIVE

• DISORDER OF INTELLECTUAL DISABILITY, PERVASIVE

• DISORDER OF INTELLECTUAL DISABILITY, OTHER

Marc J. Tassé, Ruth Luckasson, and Margaret Nygren (2013) AAIDD Proposed Recommendations for ICD–11 and the Condition Previously Known as Mental Retardation. Intellectual and Developmental Disabilities: April 2013, Vol. 51, No. 2, pp. 127-131. doi: http://dx.doi.org/10.1352/1934-9556-51.2.127

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RATIONALE• FIRST, THEY RECOMMENDED COMBINING THE PROPOSED “SEVERE” AND

“PROFOUND” CLASSIFICATIONS INTO ONE CATEGORY. • THERE IS NO SCIENTIFIC RATIONALE OR PSYCHOMETRIC VALIDITY TO

MAINTAINING A 4-LEVEL CLASSIFICATION SYSTEM. • COLLAPSING ALL INDIVIDUALS WITH IQ SCORES BELOW 40 INTO ONE CATEGORY IS

MORE SCIENTIFICALLY AND PSYCHOMETRICALLY SUPPORTED THAN ATTEMPTING TO IMPOSE A CLASSIFICATION CUT-OFF THAT IS FIVE STANDARD DEVIATIONS BELOW THE POPULATION MEAN (I.E., IQ SCORE = 25). • EXISTING STANDARDIZED TESTS OF INTELLIGENCE CANNOT RELIABLY OR VALIDLY

DISTINGUISH AMONG INDIVIDUALS WITH IQ SCORES BELOW 40. HENCE, WE PROPOSE A CLASSIFICATION OF DISORDERS OF ID WITH THREE LEVELS OF SEVERITY.

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EPIDEMIOLOGY• INTELLECTUAL DISABILITY AFFECTS APPROXIMATELY 1-4% OF THE

POPULATION IN DEVELOPED COUNTRIES.

• IN GENERAL IT IS CONSIDERED THAT 2% OF THE INDIAN POPULATION CONSTITUTES PERSONS WITH THIS DISABILITY.

• MENTAL RETARDATION IS ABOUT 1.5 TIMES MORE COMMON AMONG MEN THAN AMONG WOMEN.

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• ACCORDING TO CENSUS 2011 DATA, THERE ARE CURRENTLY 1,505,624 ‘MENTALLY RETARDED’ PEOPLE IN INDIA.

• IN RURAL AREAS, THE INCIDENCE OF MENTAL RETARDATION IS 3.1% AND IN URBAN, IT IS 0.9%.

• THE NATIONAL INSTITUTE FOR THE MENTALLY HANDICAPPED (NIMH), SECUNDERABAD MENTIONS THAT 2% OF THE GENERAL POPULATION IS INTELLECTUALLY DISABLED.

• THREE QUARTERS OF THEM ARE WITH MILD RETARDATION AND ONE-FOURTH ARE WITH SEVERE RETARDATION (PANDA, 1999).

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THE ASSAM SCENARIO• AS PER THE DATA OBTAINED FROM CENSUS 2011, THE TOTAL

POPULATION OF ASSAM IS 31,205,576 AMONG WHICH TOTAL 4,80,065 PEOPLE ARE SUFFERING FROM SOME SORT OF DISABILITY.

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TOTAL

POPULATION

TOTAL

DISABLED

TOTAL

INTELLECTUALLY

DISABLED

(previously called

mental retardation)

ASSAM 31,205,576 4,80,065 26,374

CACHAR 1,736,617 27,457 1,586

KARIMGANJ 1,228,686 18,832 1,138

HAILAKANDI 659,296 9,723 617

TOTAL OF

3 DISTRICTS

3,624,599 56012 3,341

CENSUS OF INDIA 2011

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• THIS DATA SHOWS THAT THERE CURRENTLY 26,374 PEOPLE WITH INTELLECTUAL DISABILITY IN ASSAM, WHICH IS 0.08% OF THE TOTAL POPULATION.

• IN THE DISTRICTS OF CACHAR, HAILAKANDI AND KARIMGANJ, THE TOTAL NUMBER OF INTELLECTUALLY DISABLED PEOPLE ARE 3,341 WHICH IS 0.09% OF THE TOTAL POPULATION.

• THIS FIGURE IS MUCH LESS THAN THE REPORTED PREVALENCE OF INTELLECTUAL DISABILITY REPORTED AT NATIONAL LEVEL, WHICH IS 2% OF THE TOTAL POPULATION ACCORDING TO NIMH REPORTS.

• THIS INDICATES TWO POSSIBILITIES, EITHER THERE IS A LESS INCIDENCE AND PREVALENCE OF INTELLECTUAL DISABILITY IN THIS PART OF THE COUNTRY OR A SIGNIFICANT PORTION OF INTELLECTUALLY DISABLED PEOPLE REMAIN UNDERDIAGNOSED OR NON-REPORTED.

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ETIOLOGY

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PRENATAL CAUSES• MATERNAL INFECTIONS OF RUBELLA, TOXOPLASMA ETC.

• PRENATAL USE OF TOXIC SUBSTANCES LIKE ETHANOL, CARBON MONOXIDE EXPOSURE.

• RH INCOMPATIBILITY.

• GENETIC DISORDERS:• CHROMOSOMAL ABERRATIONS: E.G. DOWN’S SYNDROME, PRADER WILLI

SYNDROME, CRI-DU-CHAT SYNDROME• DISORDERS WITH AUTOSOMAL DOMINANCE: E.G. TUBEROUS SCLEROSIS• DISORDERS WITH AUTOSOMAL RECESSIVE INHERITANCE: E.G. PHENYLKETONURIA• X-LINKED DISORDERS: E.G. FRAGILE X

• PRENATAL INJURY

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PERINATAL CAUSES• INFECTIONS E.G. HERPES SIMPLEX VIRUS 2• MECHANICAL INJURY DURING BIRTH• PERINATAL HYPOXIA• OTHER PERINATAL CAUSES LIKE RETINOPATHY

OF PREMATURITY, NEONATAL HYPERBILIRUBINEMIA

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POSTNATAL CAUSES• INFECTIONS: BACTERIAL AND VIRAL

INFECTIONS OF THE BRAIN DURING CHILDHOOD LIKE MENINGITIS OR ENCEPHALITIS.• TOXIC SUBSTANCES: E.G. EXPOSURE TO

LEAD.• OTHER CAUSES: HYPOTHYROIDISM,

DIETARY DEFICIENCIES, BRAIN TUMOURS.

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DISCUSSION ON SOME PROMINENT ETIOLOGY OF INTELLECTUAL

DISABILITY

GENETIC DISORDERS

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DOWN SYNDROME• THE SINGLE MOST IMPORTANT PRENATAL GENETIC DISORDER

RESPONSIBLE FOR INTELLECTUAL DISABILITY IS DOWN SYNDROME. THERE ARE THREE WIDELY ACCEPTED CAUSES THAT EXPLAINS THE GENETIC BASIS OF DOWN SYNDROME:

• COMPLETE TRISOMY 21• MOSAIC TRISOMY 21• TRANSLOCATION TRISOMY 21

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IN GENETICS, A MOSAIC OR MOSAICISM DENOTES THE PRESENCE OF TWO OR MORE POPULATIONS OF CELLS WITH DIFFERENT GENOTYPES IN ONE INDIVIDUAL WHO HAS DEVELOPED FROM A SINGLE FERTILIZED EGG.

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CLINICAL FEATURES• UPWARD-SLANTED PALPEBRAL FISSURES• A LOW NASAL BRIDGE WITH

EPICANTHAL FOLD• SMALL MOUTH AND EARS• SINGLE PALMER CREASE (SIMIAN

CREASE)• A FLAT NASAL BRIDGE• SHORT AND WIDE PALMS• CHARACTERISTIC DERMATOGLYPHIC

PATTERN.

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FRAGILE X SYNDROME• FRAGILE X SYNDROME IS THE SECOND MOST

COMMON SINGLE CAUSE OF ID.• THE SYNDROME RESULTS FROM A MUTATION ON THE

X CHROMOSOME AT WHAT IS KNOWN AS THE FRAGILE SITE (XQ27.3).• THE TYPICAL PHENOTYPE INCLUDES A LARGE, LONG

HEAD AND EARS, SHORT STATURE, HYPER EXTENSIBLE JOINTS, AND POST PUBERTAL MACROORCHIDISM. • THE MENTAL RETARDATION RANGES FROM MILD TO

SEVERE.

51FRAGILE X SYNDROME IS BELIEVED TO OCCUR IN ABOUT 1 OF EVERY 1,000 MALES AND 1 OF EVERY 2,000 FEMALES.

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PRADER-WILLI SYNDROME• PRADER-WILLI SYNDROME IS POSTULATED TO RESULT FROM A SMALL

DELETION INVOLVING CHROMOSOME 15, USUALLY OCCURRING SPORADICALLY. • ITS PREVALENCE IS LESS THAN 1 OF 10,000. • PERSONS WITH THE SYNDROME EXHIBIT COMPULSIVE EATING

BEHAVIOR AND OFTEN OBESITY, MENTAL RETARDATION, HYPOGONADISM, SMALL STATURE, HYPOTONIA, AND SMALL HANDS AND FEET. • CHILDREN WITH THE SYNDROME OFTEN HAVE OPPOSITIONAL AND

DEFIANT BEHAVIOR.

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PRADER-WILLI SYNDROME

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CRI-DU-CHAT SYNDROME

• CHILDREN WITH CAT'S CRY SYNDROME LACK PART OF CHROMOSOME 5.

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• SEVERE RETARDATION • MICROCEPHALY• LOW-SET EARS• OBLIQUE PALPEBRAL FISSURES• HYPERTELORISM• MICROGNATHIA. • THE CHARACTERISTIC CAT-LIKE CRY CAUSED BY LARYNGEAL

ABNORMALITIES THAT GAVE THE SYNDROME ITS NAME GRADUALLY CHANGES AND DISAPPEARS WITH INCREASING AGE.• DIFFICULTY SWALLOWING AND SUCKING• LOW BIRTH WEIGHT AND POOR GROWTH• HYPERACTIVE, AGGRESSIVE, AND REPETITIVE MOVEMENTS

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KLINEFELTER’S SYNDROME & TURNER’S SYNDROME• TURNER SYNDROME OCCURS IN 1/2500 LIVE BIRTHS. IT IS CAUSED BY

A PARTIAL OR COMPLETE ABSENCE OF ONE OF THE X CHROMOSOMES IN A FEMALE.

• IN THE CASE OF KLINEFELTER SYNDROME, THE MALE HAS 2 X CHROMOSOMES AND 1 Y CHROMOSOME

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KLINEFELTER’S SYNDROME & TURNER’S SYNDROME

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KLINEFELTER’S SYNDROME & TURNER’S SYNDROME

• CAUSED BY THE ABSENCE OF MATERIAL ON THE SEVENTH PAIR OF CHROMOSOME.

• THEIR UNUSUAL SENSITIVITY TO SOUND MAKES THEM COMPETENT IN MUSIC AND LANGUAGE DESPITE OF THEIR LOW IQ LEVEL.

WILLIAM’S SYNDROME

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WILLIAM’S SYNDROMEPHYSICAL FEATURES• SHORT STATURE• ELFINLIKE FACIES

• BROAD FOREHEAD• DEPRESSED NASAL BRIDGE• STELLATE PATTERN OF THE IRIS• WIDELY SPACED TEETH• FULL LIPS

• RENAL AND CARDIOVASCULAR ABNORMALITIES• THYROID ABNORMALITIES• HYPERCALCEMIA

BEHAVIOURAL FEATURES• ANXIETY• HYPERACTIVITY• OUTGOING• SOCIABLE• VERBAL SKILLS > VISUAL SPATIAL SKILLS

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CORNELIA DE LANGE SYNDROME• MULTIPLE GENES HAVE BEEN ASSOCIATED WITH THE CONDITION• SLOW GROWTH BEFORE AND AFTER BIRTH• INTELLECTUAL DISABILITY THAT IS USUALLY SEVERE TO PROFOUND• SKELETAL ABNORMALITIES INVOLVING THE ARMS AND HANDS• DISTINCTIVE FACIAL FEATURES

• ARCHED EYEBROWS THAT OFTEN GROW TOGETHER IN THE MIDDLE (SYNOPHRYS)• LONG EYELASHES• LOW-SET EARS• SMALL, WIDELY SPACED TEETH• SMALL, UPTURNED NOSE.

• MANIFEST SELF-INJURIOUS BEHAVIOR

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RETT'S DISORDER

• RETT'S DISORDER IS HYPOTHESIZED TO BE AN X-LINKED DOMINANT SYNDROME THAT IS DEGENERATIVE AND AFFECTS MAINLY FEMALES.

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• DECELERATION OF HEAD GROWTH BETWEEN AGES 5 AND 48 MONTHS

• LOSS OF PREVIOUSLY ACQUIRED PURPOSEFUL HAND SKILLS BETWEEN 5 AND 30 MONTHS WITH THE SUBSEQUENT DEVELOPMENT OF STEREOTYPED HAND MOVEMENTS (E.G., HAND-WRINGING OR HAND WASHING)

• LOSS OF SOCIAL ENGAGEMENT EARLY IN THE COURSE ( ALTHOUGH OFTEN SOCIAL INTERACTION DEVELOPS LATER)

• APPEARANCE OF POORLY COORDINATED GAIT OR TRUNK MOVEMENTS

• SEVERELY IMPAIRED EXPRESSIVE AND RECEPTIVE LANGUAGE DEVELOPMENT WITH SEVERE PSYCHOMOTOR RETARDATION

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NEUROFIBROMATOSIS• ALSO CALLED VON RECKLINGHAUSEN'S DISEASE• NEUROFIBROMATOSIS IS THE MOST COMMON OF THE NEUROCUTANEOUS

SYNDROMES CAUSED BY A SINGLE DOMINANT GENE, WHICH MAY BE INHERITED OR BE A NEW MUTATION. • THE DISORDER OCCURS IN ABOUT 1 OF 5,000 BIRTHS.• CHARACTERIZED BY • CAFE AU LAIT SPOTS ON THE SKIN AND BY NEUROFIBROMAS• OPTIC GLIOMAS• ACOUSTIC NEUROMAS, CAUSED BY ABNORMAL CELL MIGRATION.

• MILD MENTAL RETARDATION OCCURS IN UP TO ONE THIRD OF THOSE WITH THE DISEASE.

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NEUROFIBROMATOSIS

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TUBEROUS SCLEROSIS• TUBEROUS SCLEROSIS IS THE SECOND MOST COMMON OF THE

NEUROCUTANEOUS SYNDROMES; A PROGRESSIVE MENTAL RETARDATION OCCURS IN UP TO TWO THIRDS OF ALL AFFECTED PERSONS.

• IT OCCURS IN ABOUT 1 OF 15,000 PERSONS AND IS INHERITED BY AUTOSOMAL DOMINANT TRANSMISSION.

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VOGT’S TRIAD

• MENTAL RETARDATION• EPILEPSY• ADENOMA SEBACEUM

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CLINICAL FEATURES

ADENOMA SEBACEUM

SHAGREEN PATCH

ASH LEAF PATCH

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ADRENOLEUKODYSTROPHY• THE MOST COMMON OF SEVERAL DISORDERS OF SUDANOPHILIC

CEREBRAL SCLEROSIS, ADRENOLEUKODYSTROPHY IS CHARACTERIZED BY • DIFFUSE DEMYELINATION OF THE CEREBRAL WHITE MATTER RESULTING IN VISUAL

AND INTELLECTUAL IMPAIRMENT• SEIZURES• SPASTICITY• PROGRESSION TO DEATH.

• THE DISORDER IS TRANSMITTED BY A SEX-LINKED GENE LOCATED ON THE DISTAL END OF THE LONG ARM OF THE X CHROMOSOME.

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INBORN ERRORS OF METABOLISM

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PHENYLKETONURIA

PKU IS TRANSMITTED AS A SIMPLE RECESSIVE AUTOSOMAL MENDELIAN TRAIT AND OCCURS IN ABOUT 1 OF EVERY 10,000 TO 15,000 LIVE BIRTHS.

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CLINICAL FEATURES

• SEVERELY RETARDED, BUT SOME ARE REPORTED TO HAVE BORDERLINE OR NORMAL INTELLIGENCE. • ECZEMA• CONVULSIONS OCCUR IN ABOUT A THIRD OF ALL

PATIENTS.• THEY FREQUENTLY HAVE TEMPER TANTRUMS• OFTEN DISPLAY BIZARRE MOVEMENTS OF THEIR BODIES

AND UPPER EXTREMITIES, INCLUDING TWISTING HAND MANNERISMS• A MUSTY ODOR IN THE CHILD'S BREATH, SKIN OR

URINE, CAUSED BY TOO MUCH PHENYLALANINE IN THE BODY• FAIR SKIN AND BLUE EYES, BECAUSE PHENYLALANINE

CANNOT TRANSFORM INTO MELANIN — THE PIGMENT RESPONSIBLE FOR HAIR AND SKIN TONE• ABNORMALLY SMALL HEAD (MICROCEPHALY)

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MAPLE SYRUP URINE DISEASE• AN INBORN ERROR OF METABOLISM CAUSED BY DEFECTIVE OXIDATIVE

DECARBOXYLATION OF KETO ACIDS OF LEUCINE, ISOLEUCINE, AND VALINE.

• THESE BRANCHED-CHAIN AMINO ACIDS ARE PRESENT IN THE BLOOD AND URINE IN HIGH CONCENTRATIONS.

• MANIFESTATIONS OF DISEASE INCLUDE FEEDING DIFFICULTIES, PHYSICAL AND MENTAL RETARDATION, AND A URINE ODOR SIMILAR TO THAT OF MAPLE SYRUP; NEONATAL DEATH IS COMMON.

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LESCH-NYHAN SYNDROME• LESCH-NYHAN SYNDROME IS A RARE DISORDER CAUSED BY A

DEFICIENCY OF AN ENZYME INVOLVED IN PURINE METABOLISM.

• THE DISORDER IS X-LINKED; PATIENTS HAVE MENTAL RETARDATION, MICROCEPHALY, SEIZURES, CHOREOATHETOSIS, AND SPASTICITY.

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LESCH-NYHAN SYNDROME

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• GALACTOSEMIA - INABILITY OF THE BODY TO USE SIMPLE SUGAR GALACTOSE

• HUNTER SYNDROME – DEFECTIVE BREAKDOWN OF CHEMICAL MUCOPOLYSACCHARIDE.

• TAY-SACHS DISEASE – ABSENCE OF HEX-A ENZYME.

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MATERNAL INFECTIONS

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RUBELLA (GERMAN MEASLES)• THE MAJOR CAUSE OF MENTAL RETARDATION CAUSED BY MATERNAL

INFECTION.

• THE CHILDREN OF AFFECTED MOTHERS MAY SHOW SEVERAL ABNORMALITIES, INCLUDING CONGENITAL HEART DISEASE, MENTAL RETARDATION, CATARACTS, DEAFNESS, MICROCEPHALY, AND MICROPHTHALMIA.

• THE INCIDENCE RISES TO ALMOST 50 PERCENT WHEN THE INFECTION OCCURS IN THE FIRST MONTH OF PREGNANCY.

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CYTOMEGALIC INCLUSION DISEASE• SOME CHILDREN ARE STILLBORN, AND OTHERS HAVE JAUNDICE,

MICROCEPHALY, HEPATOSPLENOMEGALY, AND RADIOGRAPHIC FINDINGS OF INTRACEREBRAL CALCIFICATION.

• THE DIAGNOSIS IS CONFIRMED BY POSITIVE FINDINGS OF THE VIRUS IN THROAT AND URINE CULTURES.

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SYPHILIS• SYPHILIS IN PREGNANT WOMEN WAS ONCE THE MAIN CAUSE OF

VARIOUS NEUROPATHOLOGICAL CHANGES IN THEIR OFFSPRING, INCLUDING MENTAL RETARDATION.

• TODAY, THE INCIDENCE OF SYPHILITIC COMPLICATIONS OF PREGNANCY FLUCTUATES WITH THE INCIDENCE OF SYPHILIS IN THE GENERAL POPULATION.

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• TOXOPLASMOSIS

• IT CAUSES MILD OR SEVERE MENTAL RETARDATION AND, IN SEVERE CASES, HYDROCEPHALUS, SEIZURES, MICROCEPHALY, AND CHORIORETINITIS.

• HERPES SIMPLEX

• THE HERPES SIMPLEX VIRUS CAN BE TRANSMITTED TRANSPLACENTALLY, IT IS ONE OF THE MOST COMMON MODE OF INFECTION DURING BIRTH.• MICROCEPHALY, MENTAL RETARDATION, INTRACRANIAL CALCIFICATION, AND

OCULAR ABNORMALITIES MAY RESULT.

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ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)• MANY FETUSES OF MOTHERS WITH AIDS NEVER COME TO TERM BECAUSE

OF STILLBIRTH OR SPONTANEOUS ABORTION.

• OF INFANTS BORN INFECTED WITH THE HUMAN IMMUNODEFICIENCY VIRUS (HIV), UP TO HALF HAVE PROGRESSIVE ENCEPHALOPATHY, MENTAL RETARDATION, AND SEIZURES WITHIN THE FIRST YEAR OF LIFE.

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PRENATAL USE OF TOXIC SUBSTANCES

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FETAL ALCOHOL SYNDROME

• A TYPICAL PHENOTYPIC PICTURE OF FACIAL DYSMORPHISM THAT INCLUDES HYPERTELORISM, MICROCEPHALY, SHORT PALPEBRAL FISSURES, INNER EPICANTHAL FOLDS, AND A SHORT, TURNED-UP NOSE.

• THE ENTIRE SYNDROME OCCURS IN UP TO 15 PERCENT OF BABIES BORN TO WOMEN WHO REGULARLY INGEST LARGE AMOUNTS OF ALCOHOL.

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PRENATAL DRUG EXPOSURE• COCAINE• HEROIN• DIAZEPAM • PHENOBARBITAL • CHLORPROMAZINE

DEVELOPMENTAL DISORDERS

OF BRAIN FORMATION

• THE INTELLECTUAL DISABILITY USUALLY RANGES FROM SEVERE TO PROFOUND.

• THERE IS NO SPECIFIC TREATMENT AND LIFE EXPECTANCY IS LOW.

MICROCEPHALUSHOLOPROSENCEPHALY (HPE, ONCE KNOWN AS ARHINENCEPHALY) IS A CEPHALIC DISORDER IN WHICH THE PROSENCEPHALON (THE FOREBRAIN OF THE EMBRYO) FAILS TO DEVELOP INTO TWO HEMISPHERES.

• RESULTS FROM AN ACCUMULATION OF CEREBROSPINAL FLUID INSIDE OR OUTSIDE THE BRAIN.

• THE DEGREE OF INTELLECTUAL DISABILITY DEPENDS ON HOW EARLY THE CONDITION IS DIAGNOSED AND TREATED.

HYDROCEPHALUS

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COMPLICATIONS OF PREGNANCY

COMPLICATIONS OF PREGNANCY• TOXEMIA OF PREGNANCY AND

UNCONTROLLED MATERNAL DIABETES RESULT IN MENTAL RETARDATION. • MATERNAL MALNUTRITION DURING

PREGNANCY OFTEN RESULTS IN PREMATURITY AND OTHER OBSTETRICAL COMPLICATIONS. • VAGINAL HEMORRHAGE, PLACENTA PREVIA,

PREMATURE SEPARATION OF THE PLACENTA, AND PROLAPSE OF THE CORD CAN DAMAGE THE FETAL BRAIN BY CAUSING ANOXIA

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PERINATAL CAUSES

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• PREMATURE INFANTS AND INFANTS WITH LOW BIRTHWEIGHT ARE AT HIGH RISK FOR NEUROLOGICAL AND INTELLECTUAL IMPAIRMENTS THAT APPEAR DURING THEIR SCHOOL YEARS.

• INFANTS WHO SUSTAIN INTRACRANIAL HEMORRHAGES OR SHOW EVIDENCE OF CEREBRAL ISCHEMIA ARE ESPECIALLY VULNERABLE TO COGNITIVE ABNORMALITIES.

• AMONG CHILDREN WITH VERY LOW BIRTHWEIGHT, 20 PERCENT HAS SIGNIFICANT DISABILITIES, INCLUDING CEREBRAL PALSY, MENTAL RETARDATION, AUTISM, AND LOW INTELLIGENCE WITH SEVERE LEARNING PROBLEMS.

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POSTNATAL CAUSES

• NUTRITIONAL PROBLEMS• ADVERSE LIVING

CONDITIONS• INADEQUATE HEALTH CARE• LACK OF EARLY COGNITIVE

STIMULATION

ENVIRONMENTAL AND PSYCHOSOCIAL PROBLEMS

• CHILD ABUSE AND NEGLECT• TRAUMATIC BRAIN INJURY• VIRAL INFECTIONS LIKE

MENINGITIS OR ENCEPHALITIS

• HEAVY METAL POISONING ESP. LEAD POISONING

ENVIRONMENTAL AND PSYCHOSOCIAL PROBLEMS

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COMMON COMORBID PSYCHIATRIC DISORDERS

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COMMON COMORBID PSYCHIATRIC DISORDERS• INTELLECTUAL DISABILITY IS A SIGNIFICANT RISK FACTOR FOR

PSYCHOPATHOLOGY IN GENERAL.

• PSYCHIATRIC DISORDERS ARE THREE TO FOUR TIMES HIGHER IN PEOPLE WITH AN ID DIAGNOSIS THAN IN THE GENERAL POPULATION.

• THE PREVALENCE OF PSYCHIATRIC DISORDERS IN INDIVIDUALS WITH ID IS ESTIMATED TO BE BETWEEN 30% AND 60%

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• i. INTERNATIONAL STUDIES

• ERIC EMERSON ET AL (2007) IN A STUDY CONDUCTED IN BRITAIN FOUND THE PREVALENCE OF PSYCHIATRIC DISORDERS WAS 36% AMONG CHILDREN WITH INTELLECTUAL DISABILITY AND 8% AMONG CHILDREN WITHOUT

• II. INDIAN STUDIES

• A STUDY WAS CONDUCTED BY C.R.J. KHESS ET AL (1998), AT THE CHILD PSYCHIATRIC UNIT (CPU.) OF THE CENTRAL INSTITUTE OF PSYCHIATRY (C.I.P.) OVER A ONE YEAR PERIOD THE STUDY SAMPLE CONSTITUTED OF 60 PATIENTS, FOUND PSYCHIATRIC COMORBIDITY WAS PRESENT IN 34 (56.67%) PATIENTS.

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• WHEN ASSESSING FOR PSYCHIATRIC DISORDERS IN PEOPLE WITH AN ID, ASSESSMENT PROCEDURES MUST BE MODIFIED TO TAKE INTO ACCOUNT ASSOCIATED DISORDERS, SUCH AS COMMUNICATION DISORDERS, AUTISM SPECTRUM DISORDER, AND MOTOR, SENSORY, OR OTHER CO-OCCURRING CONDITIONS.

• KNOWLEDGEABLE INFORMANTS ARE ESSENTIAL DURING ASSESSMENT TO IDENTIFY CHANGES IN IRRITABILITY, MOOD REGULATION, INCREASED AGGRESSION, EATING PROBLEMS, SLEEP PROBLEMS, AND CHANGES IN ADAPTIVE BEHAVIOUR AT WORK, AT HOME, AND IN THE COMMUNITY SETTINGS.

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THE MOST COMMON PSYCHIATRIC COMORBIDITIES ASSOCIATED WITH THE INTELLECTUALLY DISABLED ARE :

• ATTENTION-DEFICIT/HYPERACTIVITY DISORDER• AUTISM SPECTRUM DISORDER• ANXIETY DISORDERS• BIPOLAR AND RELATED, DISORDER• DEPRESSIVE DISORDER• SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDER• FEEDING AND EATING DISORDER• DISRUPTIVE, IMPULSE CONTROL AND CONDUCT DISORDERS• SOMATIC SYMPTOM & RELATED DISORDER

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ATTENTION-DEFICIT/HYPERACTIVE DISORDERS• THE PREVALENCE OF ADHD IN CHILDREN WITH ID IS ESTIMATED TO

BE BETWEEN 8.7% AND 16%, COMPARED WITH 5% IN THE GENERAL POPULATION.

• FOR PERSONS WITH ID, THE DIAGNOSIS OF ADHD DEPENDS UPON THE PRESENCE OF SYMPTOMS EXCESSIVE FOR AN INDIVIDUAL’S MENTAL AGE OR REMARKABLE COMPARED WITH PEERS WHO HAVE SIMILAR LEVELS OF RETARDATION.

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• A STUDY CONDUCTED IN THE CHILD PSYCHIATRY UNIT OF A TERTIARY PSYCHIATRIC HOSPITAL BY KHESS R.J. ET AL.78 EVALUATED THAT (14%) OF THE STUDY SUBJECTS HAD COMORBID HYPERKINETIC DISORDER.

• A STUDY CONDUCTED IN THE DEPARTMENT OF PSYCHIATRY, SMCH, INCLUDING 100 ID PATIENTS, SHOWED THE PREVALENCE OF ADHD TO BE 11%

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AUTISM SPECTRUM DISORDER• IT HAS BEEN FOUND THAT INCREASED SEVERITY OF ID IS POSITIVELY CORRELATED WITH

THE INCIDENCE OF AUTISM.

• IN FACT, IT CAN SOMETIMES BE DIFFICULT TO DISTINGUISH AUTISM FROM SEVERE ID.

• HISTORICALLY, THE PREVALENCE OF INTELLECTUAL DISABILITY IN AUTISM IS ESTIMATED AT 70%, BUT RECENT STUDIES, SUGGEST THAT THE PREVALENCE OF INTELLECTUAL DISABILITY IN AUTISM-SPECTRUM CONDITIONS MAY BE CONSIDERABLY LOWER.

• IT HAS BEEN SUGGESTED THAT THE ASSOCIATION BETWEEN AUTISM AND INTELLECTUAL DISABILITY MAY BE INFLATED BECAUSE OF CLINICAL ASCERTAINMENT BIAS.

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• Cooper and colleagues FOUND THE PREVALENCE OF AUTISM SPECTRUM DISORDER TO BE 4.4% IN PERSONS WITH ID.

• A STUDY CONDUCTED IN THE CHILD PSYCHIATRY UNIT OF A TERTIARY PSYCHIATRIC HOSPITAL BY Khess r.J. Et al. EVALUATED THAT (11%) OF THE STUDY SUBJECTS HAD AUTISM.

• IN OUR STUDY WE FOUND THE PREVALENCE TO BE 3%

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ANXIETY DISORDERS• FOR PEOPLE WITH INTELLECTUAL DISABILITY, THE PREVALENCE OF ANXIETY DISORDERS HAS BEEN

SHOWN TO BE MUCH HIGHER.

• THE VARIABILITY OF PREVALENCE IS FROM 1% TO 25%. THIS MAY BE DUE TO REDUCED COGNITIVE ABILITIES AND INCREASED VULNERABILITY TO ENVIRONMENTAL DEMANDS.


• AN INDIVIDUAL WITH INTELLECTUAL DISABILITY MAY NOT BE ABLE TO IDENTIFY SUBJECTIVE ANXIETY AS AN UNDERLYING CAUSE OF DISTRESS AND THE RESULTING AGITATION AND AGGRESSION MAY BE SUGGESTIVE FOR A DIAGNOSIS OF IMPULSE CONTROL DISORDER RATHER THAN REFLECTING THE UNDERLYING ANXIETY.

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• FREQUENT SYMPTOMS OF ANXIETY IN INTELLECTUALLY DISABLED PERSONS INCLUDE AGGRESSION, AGITATION, SELF-INJURY, AND INSOMNIA. THESE SYMPTOMS ARE OFTEN DIFFICULT TO DISTINGUISH FROM IMPULSE CONTROL DISORDERS.

• ANXIETY DISORDERS OR POSTTRAUMATIC STRESS DISORDER MAY PRESENT IN RESPONSE TO FRUSTRATION OR THREATENING SITUATIONS; FEARFULNESS AND AVOIDANT BEHAVIOURS.

• PANIC ATTACKS MAY RESEMBLE RAGE OUTBURSTS, AND RESULT IN AGGRESSION OR SELF-INJURY.

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BIPOLAR AND RELATED DISORDER• AFFECTIVE DISORDERS IN ALL FORMS DO OCCUR IN PERSONS WITH

MENTAL RETARDATION.

• THE PRESENCE AND DEGREE OF MENTAL RETARDATION MODIFY MANIFESTATIONS OF THESE DISORDERS.

• DIAGNOSIS IS DIFFICULT BECAUSE OF THE ABSENCE OF CLASSICAL MANIFESTATIONS AND FREQUENT OCCURRENCE OF INTER-EPISODE BEHAVIOUR DISTURBANCES

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• A STUDY CONDUCTED IN THE CHILD PSYCHIATRY UNIT OF A TERTIARY PSYCHIATRIC HOSPITAL BY KHESS R.J. ET AL. EVALUATED THAT (8%) OF THE STUDY SUBJECTS HAD COMORBID MOOD DISORDER.


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DEPRESSIVE DISORDER• OWING TO INTELLECTUAL AND COMMUNICATION LIMITATIONS, IT IS

DIFFICULT TO USE THE PSYCHIATRIC DIAGNOSTIC INTERVIEW AND APPLY STANDARD DIAGNOSTIC CRITERIA TO THIS POPULATION. THUS, DEPRESSION MAY BE MISDIAGNOSED OR UNDERDIAGNOSED.

• THE POINT PREVALENCE OF DEPRESSION AMONG ADULTS WITH INTELLECTUAL DISABILITY IS ESTIMATED TO BE 4% (COOPER & BAILEY, 2001).


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SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDER• INDIVIDUALS WITH INTELLECTUAL DISABILITY EXHIBIT THE SAME TYPES OF

PSYCHOTIC DISORDERS AS ADULTS OF NORMAL INTELLIGENCE, ALTHOUGH AN ACCURATE DIAGNOSIS IS OFTEN DIFFICULT TO MAKE.

• DIAGNOSTIC OVERSHADOWING, FOR EXAMPLE, IN WHICH ABNORMAL BEHAVIOURS ARE ASSUMED TO BE THE RESULT OF ID RATHER THAN POTENTIAL COMORBID PSYCHOPATHOLOGY, MAY OBSCURE IDENTIFICATION OF PSYCHIATRIC CONDITIONS.

• A STUDY BY PENROSE REPORTED THAT 3.8% OF 1280 INDIVIDUALS WITH INTELLECTUAL DISABILITY HAD SCHIZOPHRENIA AND 1.9% HAD AFFECTIVE PSYCHOSES.

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• C.R.J. KHESS ET AL (1998) IN HIS STUDY REPORTED THAT 11.76% OF THE PATIENTS WERE FOUND TO HAVE PSYCHOSIS, BUT NONE FULFILLED THE CRITERIA FOR SCHIZOPHRENIA


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FEEDING AND EATING DISORDER• PICA AND RUMINATION SEEMS TO BE THE MOST COMMON EATING

DISORDER IN THE INTELLECTUALLY DISABLED.

• THE INGESTION OF NON-NUTRITIVE SUBSTANCES, REGURGITATION AND RUMINATION OCCURS WITH GREATER FREQUENCY AS THE SEVERITY OF COGNITIVE DISABILITY INCREASES.

• ANOREXIA NERVOSA AND BULIMIA NERVOSA ARE RELATIVELY UNCOMMON IN THE INTELLECTUALLY DISABLED

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• DESPITE DIAGNOSTIC AND METHODOLOGICAL DIFFICULTIES, PSYCHOPATHOLOGY AND EATING DISORDER RESEARCH STUDIES SUGGEST THAT 3-42% OF INSTITUTIONALIZED ADULTS WITH ID AND 1-19% OF ADULTS WITH ID IN THE COMMUNITY HAVE DIAGNOSABLE EATING DISORDERS (Gravestock S)


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DISRUPTIVE, IMPULSE CONTROL AND CONDUCT DISORDERS• IMPULSE CONTROL DIFFICULTIES REPRESENT A MAJOR FEATURE OF A

NUMBER OF BEHAVIOURAL AND MENTAL DISORDERS IN CHILDREN, YOUTH, AND ADULTS WITH INTELLECTUAL DISABILITIES (ID).

• Khess R.J. et al.IN THEIR STUDY EVALUATED THAT (2%) OF THE STUDY SUBJECTS HAD COMORBID CONDUCT DISORDER.

• IN OUR STUDY WE FOUND THE PREVALENCE RATE TO BE 3%

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SOMATIC SYMPTOM & RELATED DISORDER• SOMATIC SYMPTOM & RELATED DISORDER IS LARGELY COMMON IN

PATIENTS WITH ID.

• MOSTLY, IT IS SEEN IN PATIENTS WITH MILD AND MODERATE ID.

• HOWEVER, THE PREVALENCE RATE IS NOT SO WELL RESEARCHED.

• IN OUR STUDY, WE FOUND THE PREVALENCE TO BE 5%

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INTELLECTUAL DISABILITY &

SUBSTANCE ABUSE

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• SLAYTER (2010) REVIEWED HEALTHCARE BILLING CLAIMS AND CONCLUDED THAT 2.6% OF ALL PEOPLE WITH ID HAD A DIAGNOSABLE SUBSTANCE ABUSE DISORDER.

• OTHER ESTIMATES USING DIFFERENT METHODOLOGIES VARY WIDELY, RANGING AS HIGH AS 26% (STRAIN, BUCCINO, BROONER, SCHMIDT, & BIGELOW, 1993).

• WHEN A PERSON WITH ID ALSO HAS A MENTAL ILLNESS OR A DUAL DIAGNOSIS, THE ESTIMATES OF CO-OCCURRING SUBSTANCE ABUSE RANGE FROM 7% TO 20% (SINCLAIR, 2004).

• THE RESEARCH IN THIS AREA IS SPARSE, BUT THE NUMBERS ARE ALARMING.

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• PEOPLE WITH ID WHO ARE SUBSTANCE ABUSERS SHARE SOME UNIQUE TRAITS.

• AS A GROUP, THEY TEND TO BEGIN DRINKING ALCOHOL A COUPLE YEARS LATER THAN THEIR PEERS WITHOUT ID (SLAYTER).

• THEY ARE LESS LIKELY TO SEEK HELP FOR THEIR PROBLEM AND EVEN WHEN THEY DO, THE RESOURCES THAT ARE HELPFUL FOR THE GENERAL PUBLIC FALL SHORT OF MEETING THEIR NEEDS.

• ADDITIONALLY, THIS GROUP IS AT GREATER RISK OF COMPLICATIONS FROM DRINKING BECAUSE THEY TEND TO BE PRESCRIBED MEDICATIONS FOR OTHER CONDITIONS, SUCH AS SEIZURES, METABOLIC DISORDERS, AND CO-OCCURRING MENTAL ILLNESS THAT MIGHT NEGATIVELY INTERACT WITH ALCOHOL AND DRUGS.

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SEIZURE DISORDER IN INTELLECTUAL DISABILITY

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SEIZURE DISORDER IN INTELLECTUAL DISABILITY• WHEN CONSIDERED ACROSS THE SPECTRUM OF INTELLECTUAL DISABILITY, THE

FREQUENCY AND SEVERITY OF EPILEPSY VARIES INVERSELY WITH THE LEVEL OF MENTAL RETARDATION (ROBERTS, 1986).

• AMONG INDIVIDUALS WITH MILD RETARDATION, THE DISTRIBUTION OF VARIOUS SUBTYPES OF SEIZURES APPROXIMATES THE GENERAL POPULATION.

• AMONG INDIVIDUALS WITH SEVERE/PROFOUND RETARDATION, INCREASED RATES OF UNDERLYING NEUROLOGICAL ABNORMALITIES ARE MANIFESTED BY A HIGHER FREQUENCY OF MIXED SEIZURE DISORDERS, AND AN ONSET OF SEIZURES IN INFANCY OR EARLY CHILDHOOD (RATEY & DYNEK, 1996; ROBERTS, 1986).

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• COMMUNITY-BASED STUDIES OF EPILEPSY IN ADULTS WITH ID SHOW A PREVALENCE OF 16–26%. BOWLEY, C. ET AL (2000).

• IN OUR STUDY WE FOUND THE PREVALENCE RATE TO BE 22%

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TO BE CONTINUED…..IN PART - II

• MANAGEMENT OF INTELLECTUAL DISABILITY• SERVICES AND SUPPORT

• LEGAL ASPECTS

THANK YOU

INTELLECTUAL DISABILITY PART- I

Health & Medicine